Problems of achieving a satisfactory erection are fairly common. If the problem does not originate from lack of lust and is great enough to make normal intercourse impossible, the condition is called erectile dysfunction (impotence). Erection problems are caused by combined physical and psychological factors.

THE ERECTION MECHANISM

The penis has three bodies containing a dense network of blood vessels along all its length. During erection blood is filled into the vessels of these bodies. The bodies then engorge, make the penis hard and rise it up. The filling of these bodies occur when the vessels leading blood to the penis relax and vessels draining the penis constrict their volume.

Before and during erection nerves lead impulses to the genitals. The nerve ends in this area then releases the substance nitrogen oxide. Nitrogen oxide will diffuse through the genital area and the penis and stimulate the reaction of the blood vessels in the penis.

PHYSICAL CAUSES OF ERECTION PROBLEMS

Erection problems can occur because of disorders in the nervous system sending impulses to the genital area, problems with the blood supply to the penis and anatomical problems in the penis or genital area. Specific causes can be:

- Accidents, stroke, surgery or tumours hurting brain areas or areas in the spinal cord responsible for erection impulses. - Multiple sclerosis, a disease hurting the isolating sheets around the neural fibres in the brain and spinal cord, can give erection problems. - Accidents or diseases hurting nerves from the spinal cord to the genital region. - Atherosclerosis caused by age or an unhealthy lifestyle, giving narrowing and hardening of blood vessels to the genital region. - Injury to the erectile bodies caused by inflammation, accidents or diseases. - Congenital malformations in the penis or genital region, for example hypospadias and epispadias. - Peyronie's disease, a common inflammatory disease causing abnormal bending or twisting of the penis, and sometimes also hinder the filling of blood into the erectile bodies, sometimes gives problems for the erections. - Circumcision causing the penile skin to be too tight, or causing extensive inelastic scars. - Side effects of medicines, such as medications taken for high blood pressure or depression. - Zinc deficiency. - Heart disease. - Diabetes causing injury to the nerves and blood vessels to the penis. . High blood pressure (hypertension). . Liver or kidney disease. - Alcohol or drug abuse impairing psychological and neural functions.

PSYCHOLOGICAL CAUSES OF ERECTION PROBLEMS

Psychological causes can interfere with the erection process by distracting a man from stimuli that normally would give him sexual arousal. Psychological issues account for about 40% of erection problems. Erection problems in men under age 50 are most likely to be caused by psychological factors. Psychological causes of erection problems include:

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